CBT Today

Ah ha – I have an interview in ‘CBT Today’. It’s a journal about Cognitive Behavioral Therapy.

And if that print is too small to read, don’t worry it goes something like this:

We are both mental health nurses although I am pre-project 2000 and therefore prehistoric. How old were you when you started mental health nurse training?

I was a spritely twenty-one year old. That’s also when I first started to imagine my novel, or at least its central character. I’m thirty-three now and have started saying things like: ‘Gosh, where does the time go?’

But seriously. Where does it go?

Why mental health nursing and where did you train?

I trained at UWE in Bristol. Our campus was made up of incredible old buildings that – at various junctures in their history – have served as a prison, a workhouse and an asylum. I think their current incarnation is probably the best yet.

I’ve recently been invited back to give a talk about my novel in the Student Library. It’ll be strange walking through those doors again, but I’m really looking forward to it too.

As to why mental health – it’s hard to say. I worked as a Health Care Assistant in a general hospital first (as did my mum, so perhaps it’s in the blood). I didn’t even know mental health wards existed until a colleague of mine suggested that I might find it interesting.

I never looked back.

How difficult was it to steer your story away from being a polemic against the chronic failings of mental health services?

I met with lots of difficulties in writing this story, but that wasn’t really one of them.

For me it was never going to be a polemic against anything. At its heart it’s the story of a young man called Matthew who really misses his dead brother. My job was to inhabit Matthew as a character: to prioritise his priorities and to let it be his story that unfolded. I never felt an urge to push an agenda onto him.

That isn’t to say that when he encounters mental health services he isn’t critical. He clearly is. But I think Matthew is surprisingly understanding towards the doctors and nurses who treat him, even when this treatment is against his will and delivered poorly. He seeks to find the good in them – and, indeed, they are good people. Flawed, of course. But ultimately trying their best in difficult circumstances. I wanted to avoid writing a novel where the mental health staff were the villains, or the system corrupt. That’s an over-simplification, and not one that Matthew would make.

As for the closure of the Day Centre in the novel, I can see how this might be interpreted as a political statement. And perhaps it was, a bit. But I was only interested in this insofar as it affected the characters in the story. It’s a book about them, not the health service.

As a CBT therapist I am expected to use a variety of rating scales to assess the life out of my clients. There are times when completing these forms I feel like a little piece of each of us dies. In the novel Matthew expresses frustration at the way the data collected takes control away from him and his life. CBT therapists pride themselves on their collaborative approach to therapy. Do you think we are kidding ourselves?

There’s a chapter in the novel called Is this question useful? which is modelled on a Likert scale. Matthew is not only frustrated by the questions he is asked, he’s afraid of them. He’s afraid of what giving the wrong answers (or indeed, the truthful answers) will mean.

Rating scales clearly have their uses. But I think they can encourage us to be too reductive in our thinking. Almost by definition, they place people in boxes.

Take the Becks Depression Inventory, which I’ll hazard a guess you are very familiar with. As a validated measure it has this kind of holy status in mental health, especially in research where to design a depression study without it would be unthinkable. But to my mind the BDI, and many other rating scales, tend to simplify the experience of illness by focussing on symptoms within the individual (your sleep, your appetite, your libido etc). The ‘location’ of illness is very interesting to me, and is a concept that I seek to explore in The Shock of the Fall. The mental health problems of Matthew and his mum reside as much in the space between them as they do within either one of them.

I’m sure there is much written about this and far more coherently than I’m managing. But I suppose my broad point would be that when we are totting up scores on a questionnaire and assigning a single numeric value to a person’s experiences, as though measuring their shoe size – we’re probably missing a few things out. And we may well be missing out the things that are most important to the person sitting in front of us. If we don’t consider that, then yes – we’re kidding ourselves.

CBT dominates the market in self –help. The ‘Overcoming Series’ covers pretty much everything aside from Death. Do you think that novels as well as self –help literature should be included in current recommended mental health reading lists?

It’s a nice thought, isn’t it? I think that a big part of the wonder of novels is that they make us feel less alone. We see ourselves in others and we empathize. We empathize with the most unlikely characters.

But I wouldn’t go so far as prescribing which novels people should read. We do enough prescribing already.

In ‘The Shock of the Fall’ Matthew was painfully aware of his own character deficiencies which he owned right at the start of the novel. What are yours?

How long have you got?

Compassionate Focused Therapy and Mindfulness are both part of the third wave of CBT Therapies. CFT encourages clients to imagine their ideal compassionate image. It can be a human or fictional character . Matthew’s Grandmother, the glorious Nanny Noo is for me the embodiment of the ideal nurturer. Who or what inspired the creation of Nanny Noo?

I love Nanny Noo so much and it gladdens my heart when readers talk about her. She’s a clear favourite.

Interestingly she started off as quite a minor character in the early drafts, but she was so nice to write that I ended up giving her more and more work to do and now it is impossible to imagine the novel without her.

I’m aware that I do give Matthew a fairly hard time in this story, so it was important to me that I gave him a source of strength and hope as well. This came in the form of Nanny Noo who borrows traits from both of my grandmothers, but has many all of her own.

I think our relationship with our grandparents is a really intriguing one, something about how we are a step removed. There is less pressure than exists in the relationship with our parents, but still (hopefully) lots of love. I think if we all had a Nanny Noo (or perhaps CFT, then) our lives would be happier, and we’d score less on those rating scales.